Consequences of Preoperative Evaluation of Patterns of Drainage of the Cavernous Sinus in Patients Treated Using the Anterior Transpetrosal Approach

T he superficial middle cerebral vein (SMCV) usually runs inferiorly and anteriorly along the sylvian fissure and leads into the sphenoparietal sinus or directly into the cavernous sinus (CS). 3,5,13,25,27 Hacker classified the SMCV drainage pattern into 4 types: 1) sphenoparietal sinus, 2) sphenobasal vein (SBV), 3) sphenopetrosal vein, and 4) cortical veins with the absence of a definite SMCV. 9The anterior transpetrosal approach (ATPA) is best suited for upper petroclival lesions located anterior and superior to the internal auditory canal and superior to the inferior petrosal sinus.15,16 Epidural procedures and dural incision of the middle temporal fossa in ATPA may interrupt drainage routes from the SMCV.It has been demonstrated that surgical interruption of the SMCV leads to temporal lobe damage. obJective The drainage of the superficial middle cerebral vein (SMCV) has previously been classified into 4 subtypes. Extradural procedures and dural incisions during the anterior transpetrosal approach (ATPA) may interrupt the route of drainage from the SMCV. In this study, the authors examined the relationship between anatomical variations in the SMCV and the corresponding surgical modifications to the ATPA that are necessary for venous preservation. methods This study included 48 patients treated via the ATPA in whom the SMCV was examined using 3D CT venography. The drainage patterns of the SMCV were classified into 3 types: cavernous or absent (Type 1), sphenobasal (Type 2), and sphenopetrosal (Type 3). Type 2 was subdivided into medial (Type 2a) and lateral (Type 2b), and Type 3 was subdivided into vein (Type 3a), vein and sinus (Type 3b), and sinus (Type 3c). The authors performed 3 ATPA modifications to preserve the SMCV: epidural anterior petrosectomy with subdural visualization of the sphenobasal vein (SBV), modification of the dural incision, and subdural anterior petrosectomy. Standard ATPA can be performed with Type 1, Type 2a, and Type 3a drainage. With Type 2b drainage, an epidural anterior petrosectomy with subdural SBV visualization is appropriate. The dural incision should be modified in Type 3b. With Type 3c, a subdural anterior petrosectomy is required. results The frequency of each type was 68.7% (33/48) in Type 1, 8.3% (4/48) in Type 2a, 4.2% (2/48) in Type 2b, 14.6% (7/48) in Type 3a, 2.1% (1/48) in Type 3b, and 2.1% (1/48) in Type 3c. No venous complications were found. coNclusioNs The authors propose an SMCV modified classification based on ATPA modifications required for venous preservation.

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“…4A). 4,10 The middle meningeal artery is coagulated and cut. The GPN is dissected in the interdural layer to preserve the nerve.…”

Section: Basic Concept Of the Atpamentioning

confidence: 99%

“…21 Hayashi et al reported a relationship between the venous pattern encountered in the ATPA and surgical results. 10 They concluded that venous drainage from the CS should In Type 2b, we should perform an epidural anterior petrosectomy with subdural visualization of the SBV (E). F-h: Comparison of Types 3a-c.…”

Section: 6729mentioning

confidence: 99%

Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach

Shibao

Toda

Orii

et al. 2016

JNS

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“…Sphenoidal emissary veins (Vesalian or Meckel's veins) connect the cavernous sinus with the pterygoid or pharyngeal plexuses (Dwight et al 1913;Gray 1918;Hayashi et al 2010). These veins are not constant and are only found in approximately one in three cases (Dwight et al 1913).…”

Section: Sphenoidal Emissary Vein (Vesalius)mentioning

confidence: 99%

Emissary Veins

Tubbs¹,

Watanabe²,

Loukas³

2016

Bergman's Comprehensive Encyclopedia of Human Anatomic Variation

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“…A sphenoidal emissary foramen is present in 20% of individuals, which is located at the root of the greater sphenoid wing medial to the foramen ovale. This foramen contains an emissary vein connecting the CS and pterygoid venous plexus, which may be a source for bleeding during lateral extradural dissection [32,35]. Extensive dissection of the ICA may result in injury and leaving tumor remnants attached to important blood vessels is often prudent.…”

Section: Complication Avoidancementioning

confidence: 99%

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

Chotai

Kshettry

Petrak

et al. 2015

Clinical Neurology and Neurosurgery

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Consequences of Preoperative Evaluation of Patterns of Drainage of the Cavernous Sinus in Patients Treated Using the Anterior Transpetrosal Approach

Cited by 17 publications

References 14 publications

Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach

Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach

Emissary Veins

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

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